European Society of Cardiology Cardiovascular diseases in women

2 2 Cardiovascular diseases in women Fast facts Cardiovascular disease (CVD) is the primary cause of death in European women It kills a higher percentage of women (55%) even than men (43%) and more than all cancers combined. However, there still exists a disturbing gap in the knowledge, understanding, and general awareness of cardiovascular disease in women, across medical audiences as a whole. Cardiovascular disease (CVD) is the primary cause of death in European women It kills a higher percentage of women (55%) even than men (43%) and more than all cancers combined. However, there still exists a disturbing gap in the knowledge, understanding, and general awareness of cardiovascular disease in women, across medical audiences as a whole.

European Society of Cardiology The impact of underestimation As a frightening consequence of the underestimation of cardiovascular diseases in women, risk factors for heart disease are raising among women > Specific campaigns on prevention of cardiovascular diseases in women are needed

European Society of Cardiology The heart of men and women Clinical and epidemiological studies have shown that men and women with cardiovascular disease differ with respect to disease processes, clinical presentations, and outcomes.

European Society of Cardiology What is different in CVD in Women? Women develop heart disease later in life than men; Women are more likely to have co-morbidities that may mask symptoms of heart disease; Symptoms of a heart attack in women may differ from those in men, leading to a misdiagnosis of the disease; Post MI women who are more likely to have a stroke or another heart attack than men; 42% of women die within one year following a heart attack vs. 24% of men. Women develop heart disease later in life than men; Women are more likely to have co-morbidities that may mask symptoms of heart disease; Symptoms of a heart attack in women may differ from those in men, leading to a misdiagnosis of the disease; Post MI women who are more likely to have a stroke or another heart attack than men; 42% of women die within one year following a heart attack vs. 24% of men.

European Society of Cardiology The impact of CVD in Women As compared to men, women have a poorer prognosis and experience greater disability moreover they: Are at a higher risk of psychosocial distress; Have a greater need for instrumental support and social support; Have an altered perception of risk; Demonstrate the need for specific rehabilitation programs, tailored to their needs. Davidson et al 2001

European Society of Cardiology Do we have data to cure the heart of women? The enrolment of women in clinical trials came under scrutiny in the mid-1980s with the realisation that less information about treatment was available for women with cardiovascular disease than for men with the disease.

European Society of Cardiology Gender specific differences in the effects of treatment To determine definitively whether an intervention or therapy affects women and men differently, the trial must include a number of women to ensure that the study has the statistical power to evaluate the effect of the intervention in each sex and to compare the magnitude of these effects.

European Society of Cardiology Moving in the right direction In 1993 the NIH Revitalization Act required the inclusion of women in every clinical trial involving a disorder that affects women to: “….ensure that the trial is designed and carried out in a manner sufficient to provide for a valid analysis of whether the variables being studied in the trial affect women [and men] differently." In 1993 the NIH Revitalization Act required the inclusion of women in every clinical trial involving a disorder that affects women to: “….ensure that the trial is designed and carried out in a manner sufficient to provide for a valid analysis of whether the variables being studied in the trial affect women [and men] differently."

European Society of Cardiology Conclusion Cardiovascular diseases are a major cause of morbidity and mortality female patients; The pivotal role of CVD in women is under recognized by citizens and physicians alike; The distinguishing aspects of CVD in women are not familiar to medical professionals. Cardiovascular diseases are a major cause of morbidity and mortality female patients; The pivotal role of CVD in women is under recognized by citizens and physicians alike; The distinguishing aspects of CVD in women are not familiar to medical professionals.

European Society of Cardiology A need for action Need for a fair gender representation in clinical trials; Promote research both at clinical and basic level to understand more on CV Physiology in females; Assess if gender specific differences exist in the response to therapy. Need for a fair gender representation in clinical trials; Promote research both at clinical and basic level to understand more on CV Physiology in females; Assess if gender specific differences exist in the response to therapy.

European Society of Cardiology Objectives Three main goals need to be achieved to impact CVD in women: Education of the Profession Education of the Patients Collection of epidemiological and outcome data Three main goals need to be achieved to impact CVD in women: Education of the Profession Education of the Patients Collection of epidemiological and outcome data

European Society of Cardiology The ESC effort to fill the gap The European Society of Cardiology is committed to provide education and research on the topic of CVD in women and has therefore organized a targeted initiative. Women at Heart, the ESC program on CVD in women will act in synergy with existing initiatives that are taking place in Europe and in the USA

European Society of Cardiology Committed to Improving Heart Health for Women An initiative of the European Society of Cardiology

European Society of Cardiology Primary target audience = Medical Profession 2.Focus on the scientific underpinning of the topic 3.ESC strive to provide evidence based information for various stakeholders 4.Not a PR campaign Women at Heart Distinguishing profile of the ESC initiative

European Society of Cardiology Women at Heart Policy Conference on CVD in Women Meeting of more than 62 experts and representatives of National Societies, Working Groups and Associations Production of a scientific and political statement on the topic, to be published in the European Heart Journal June 2005, European Heart House

European Society of Cardiology Women at Heart European Data on CVD in Women Analysis from the EuroHeart Survey databases On epidemiology of CVD in women and women’s access to treatment > Preparation of a comprehensive summary of results/ original educational material

European Society of Cardiology Women at Heart ESC Congress 2005 S pecial focus on women and CVD, in the main sessions, through dedicated sessions, oral abstracts and posters presentations Specific information on risk factor reduction through lifestyle improvements, at the ESC public event, ‘For Your Heart’s Sake, 2-4 September 2005, Stockholm, Sweden. 3-7 September 2005 Stockholm, Sweden

European Society of Cardiology Women at Heart Next Steps Through the ESC network of 49 affiliated countries, National Cardiac Societies are taking up the challenge and adapting the initiative at a national level. Increased awareness of women’s CVD patterns Improved quality of care of women with heart disease and stroke across Europe.

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